Fludarabine phosphate

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Fludarabine phosphate
Fludarabine phosphate (Fludara)
Fludarabine phosphate
(floo- DAIR-ah-bean)
Pregnancy Category: D Fludara (Rx)

Classification: Antineoplastic, antimetabolite

See Also: See also Antineoplastic Agents .

Action/Kinetics: Rapidly dephosphorylated to 2-fluoro-ara-A and then phosphorylated within the cell by the enzyme deoxycytidine kinase to the active 2-fluoro-ara-ATP. This compound inhibits DNA polymerase alpha, ribonucleotide reductase, and DNA primase, resulting in inhibition of DNA synthesis. t 1/2, 2-fluoro-ara-A: About 10 hr. Approximately 23% of a dose of fludarabine is excreted in the urine as unchanged 2-fluoro-ara-A.

Uses: Chronic lymphocytic leukemia in individuals who have not responded to at least one standard alkylating agent-containing regimen. Investigational: Non-Hodgkin's lymphoma, macroglobulinemic lymphoma, prolymphocytic leukemia or prolymphocytoid variant of chronic lymphocytic leukemia, mycosis fungoides, hairy cell leukemia, Hodgkin's disease.

Contraindications: Lactation.

Special Concerns: Use with caution in clients with renal insufficiency. The safety and effectiveness of fludarabine in children and in previously untreated or nonrefractory chronic lymphocytic leukemia clients have not been established. Fludarabine produces dose-dependent toxic effects. An increased risk of toxicity is possible in geriatric clients, in renal insufficiency, and in bone marrow impairment.

Side Effects: Hematologic: Neutropenia, thrombocytopenia, anemia. Tumor lysis syndrome: Hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia, hematuria, metabolic acidosis, urate crystalluria, renal failure. Flank pain and hematuria may signal the onset of the syndrome. GI: N&V, anorexia, stomatitis, diarrhea, GI bleeding. CNS: Malaise, fatigue, weakness, agitation, confusion, coma. Neuromuscular: Peripheral neuropathy, paresthesia, myalgia. Respiratory: Pneumonia, dyspnea, cough, interstitial pulmonary infiltrate. GU: Dysuria, urinary infection, hematuria. Miscellaneous: Edema (common), skin rashes, fever, chills, serious opportunistic infections pain, visual disturbances, hearing loss.

Overdose Management: Symptoms: Irreversible CNS toxicity including delayed blindness, coma, and death. Severe thrombocytopenia and neutropenia. Treatment: Discontinue administration of the drug and treat symptoms. Monitor the hematologic profile.

How Supplied: Powder for injection: 50 mg

Adults, usual: 25 mg/m 2 given over a period of 30 min for 5 consecutive days. Initiate a 5-day course of therapy every 28 days.

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